Healthcare Provider Details

I. General information

NPI: 1073631479
Provider Name (Legal Business Name): JOSEPH D BERTAGNOLLI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 BROADWAY SUITE 1P
DENVER CO
80221-2915
US

IV. Provider business mailing address

7280 BRADBURN BLVD
WESTMINSTER CO
80030-5224
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-5800
  • Fax: 303-650-5801
Mailing address:
  • Phone: 303-429-6222
  • Fax: 303-429-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9156
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: